Provider Demographics
NPI:1700191152
Name:VICTORIOUS IMAGES, LLC
Entity Type:Organization
Organization Name:VICTORIOUS IMAGES, LLC
Other - Org Name:VICTORIOUS IMAGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:PHILLIPS
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-476-7335
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:NORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23127-0638
Mailing Address - Country:US
Mailing Address - Phone:757-476-7335
Mailing Address - Fax:757-476-7336
Practice Address - Street 1:6961 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7212
Practice Address - Country:US
Practice Address - Phone:757-476-7335
Practice Address - Fax:757-476-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier